Umbilical-cord

A free gallery of high-resolution, ultrasound, color doppler and 3D images

Ultrasound images of pathology/ complications of the umbilical cord:

Umbilical cord prolapse

Umbilical vein varix

Extra-abdominal umbilical vein varix

Fetal intra-abdominal umbilical vein varix

Single umbilical artery (SUA) or 2 vessel umbilical cord

Normal 3 vessel umbilical cord

Nuchal cord or Umbilical cord around fetal neck

Hypocoiled umbilical cord

Case-2:_hypocoiling_of_umbilical_cord

Case-3:_Hypocoiled_umbilical_cord

Normal coiling of the umbilical cord

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Umbilical cord prolapse:

This 21 week gestation had labour contractions with leaking per vaginum. On color doppler scan, the internal os appears dilated with umbilical cord seen within the cervix. These ultrasound and color doppler images are diagnostic of umbilical cord prolapse. Images taken with a Nemio 30 (Toshiba) color doppler machine by Dr. Vikas Arora, Ferozepur, India.

Reference: http://www.emedicine.com/med/topic3276.htm (free article).

Umbilical vein varix:

a) Extra-abdominal umbilical vein varix (varix inside the umbilical cord):

Routine obstetric sonography was done on this patient. Images reveal a cystic lesion in the umbilical cord close to the fetal abdomen. On color doppler scan, flow is present in the cystic area which shows continuity with the umbilical vein. These ultrasound and color doppler images suggest umbilical vein varix (within the cord). Images courtesy of Dr. Latha Natarajan, bangalore, India. She used an Aloka machine for these images.

b) Fetal intra-abdominal umbilical vein varix:

This 3rd trimester fetus shows a focal cystic lesion (2.2 x 2.4 cms.) close to the dome of the fetal urinary bladder. Using color doppler imaging, the lesion shows considerable vascularity, with spectral waveform suggestive of a venous flow. The vascular "cystic" lesion shows continuity with the fetal intra-abdominal umbilical vein suggesting a fetal intra-abdominal umbilical vein varix. No other fetal anomalies were seen.

Images taken using a Logiq 3 Color Doppler machine (GE) by Joe Antony, MD., Cochin, India.

Reference: 1) http://www.thefetus.net/page.php?id=187 (free article and images)

2) http://www.thefetus.net/page.php?id=2193 (free article and images)

Single umbilical artery (SUA) or 2 vessel umbilical cord:

These (above) ultrasound and color Doppler images show a 3rd trimester pregnancy with an interesting anomaly of the umbilical cord. There are only 2 vessels seen in the umbilical cord. Normally, there are 2 umbilical arteries and 1 umbilical vein running within the umbilical cord. However, in this case, there is only one umbilical artery and an umbilical vein within this cord. This ultrasound finding is called a single umbilical artery (SUA) or 2 vessel cord and is associated with increased fetal morbidity including single/ multiple fetal congenital anomalies, still birth and premature delivery. However, no other anomaly was found in this fetus. The ultrasound images above were taken showing transverse sections of the cord along multiple levels to display the SUA (single umbilical artery). Ultrasound images were taken using a GE logiq 3 ultrasound machine.

Some more color Doppler images are shown above (same case).

References: http://www.medscape.com/viewarticle/453593

http://emedicine.medscape.com/article/262470-overview (free article and images)

Normal 3 vessel umbilical cord:

These ultrasound and color Doppler images show the normal umbilical cord with three vessels within it (compare with the 2 vessel cord in previous case). Cross section ultrasound images of the normal umbilical cord show 2 umbilical arteries (the smaller caliber vessels) and the larger caliber umbilical vein. The presence of sufficient liqor (amniotic fluid) helps to highlight the vessels, nicely.

Nuchal cord or Umbilical cord around fetal neck:

The above color Doppler ultrasound images show a 35 weeks old fetus with a single loop of umbilical cord around the fetal neck. The images show a 360 degree loop around the neck and more, (see the sagittal section image), that there is only a single loop of umbilical cord ( arrowheads) around the neck. The sagittal section image shows a single cord loop posteriorly- meaning thereby that the nuchal cord, in this case, is not as significant and possibly safer than multiple umbilical cord loops around the fetal neck. Basically, there are two types of cord loops around the fetal neck-

Type A- where the umbilical nuchal cord encircles the fetal neck in a sliding manner (less dangerous) and,

Type B- where the nuchal cord encircles the neck in a locking manner (very dangerous). The color Doppler images of the case above suggest a single loop of cord in a sliding manner.

Color Doppler videos of this case are available at:

http://ultrasound-videos.blogspot.com/2011/03/nuchal-cord-in-late-3rd-trimester.html

References: http://sites.google.com/site/drjoea/gallery-fetal

http://en.wikipedia.org/wiki/Nuchal_cord

Hypocoiled umbilical cord:

The normal umbilical cord extends from the placenta to the fetal umbilicus, twisting (coiling) as it traverses the distance between these two points. The umbilical cord contains two umbilical arteries and an umbilical vein which are normally coiled. Uncoiling or hypocoiled umbilical arteries are associated with increased fetal morbidity, including small for gestational age babies (fetuses). The above ultrasound and color Doppler images show an almost straight umbilical cord with almost no coils (hypocoiled cord). Such ultrasound findings are also associated with increased incidence (almost 64 %) of abnormal umbilical cord insertions, ie: marginal or velamentous. This case and images are courtesy of Dr. Durr -e-Sabih, Pakistan.

References: 1) http://www.ncbi.nlm.nih.gov/pubmed/10395130

2) http://www.ajog.org/article/S0002-9378%2805%2900068-2/abstract

Case-2: hypocoiling of umbilical cord:

This is yet another case of hypocoiled umbilical cord. The color Doppler image above shows an almost straight cord. The umbilical cord coiling index is calculated by the total length of the cord in centimeters divided by the total number of coils in the cord. Another method of calculating the umbilical coiling index is: 1/ distance in centimeters between a pair of coils (intercoil distance) of the cord. The normal umbilical coiling index varies from 0.19 to 0.21 (based on studies by Ercal et al). Studies done on Indian pregnancies show normal UCI values ranging from- 0.13 to 0.21. Other studies have found that umbilical coiling index less than the 5th percentile is diagnostic of hypocoiled umbilical cord. This color Doppler ultrasound image is courtesy of Dr. Durr-e-Sabih, Pakistan.

Reference: http://medind.nic.in/jaq/t06/i4/jaqt06i4p315.pdf (free journal article- umbilical cord coiling index)

http://www.sirirajmedj.com/content.php?content_id=2539 (free article on method of umbilical cord coiling index and its use as an indicator of Trisomy 21). This article also has an image demonstrating the method of coiling index measurement.

http://www.hkmj.org/supplements/article_pdfs/hkm0702sp1p44.pdf (free article on umbilical cord morphology

and umbilical coiling index (UCI)).

Case-3: Hypocoiled umbilical cord:

This early 3rd trimester fetus showed a markedly hypocoiled cord. The intercoil distance here is more than 8 cms. Hence the UCI or umbilical coiling index is= 1/8 which is less than 0.12. (very low).

Normal coiling of the umbilical cord:

This 23 week old pregnancy shows the normal umbilical cord. The ultrasound and color Doppler sonography images show the normal twists in the umbilical cord (arrows). Contrast this cord to the previous case of hypocoiled umbilical cord. The difference is obvious.

Also see the color Doppler video clip of this case at: color Doppler video of normal umbilical cord

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This page was last edited on: Saturday September 03, 2011 04:18 PM

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